The Utah MEDEX Project, under the direction of the Department of Community and Family Medicine, University of Utah College of Medicine, will implement a two-way voice communications system between the communities of Challis, Idaho and Salmon, Idaho in order to facilitate the supervision of a remotely deployed Medex (physician's assistant) by a primary care physician. Evaluation mechanisms will be developed in order to measure the success of the proposed system and test the feasibility of implementing alternative systems designed to further improve medical communications and appropriate physician assistant supervision. The goal of the Salmon-Challis Medical Communications Project is to improve the accessibility to high quality medical care for the residents of Challis, Idaho and to demonstrate the practicability of replicating the communication system in other sites throughout the Intermountain Region where physician's assistants may ultimately be remotely deployed. A Project Evaluator will be recruited to oversee data collection and analyze the results. Data will be collected before the system is implemented and during the period of time when it is in use in order to determine its overall impact. Sites and facilities have already been identified and the Idaho State Communication Commission has agreed to assist in securing Federal Communications Commission licensure of the system.